MidCoast CHNA FY14

Mid Coast Hospital | Community Health

Needs Assessment (CHNA) &
Implementation Strategies | FY2014-‐16

MID COAST HOSPITAL | COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) & IMPLEMENTATION STRATEGIES | FY2014-‐16 1

Community Health Needs Assessment and Implementation Strategies
FY2014-‐16 (October 1, 2013 – September 30, 2016)
Background
On March 23, 2010 the Affordable Care Act (ACA) was enacted. The ACA, among other things, requires
hospitals to perform Community Health Needs Assessments (CHNA) every three years. The requirement
took effect for tax years beginning on or after March 23, 2012 which for Mid Coast Hospital is fiscal year
ending September 30, 2013. The requirement also allows the CHNA to be performed in the applicable
tax year or in either of the two preceding years.
Beginning in 2010 and ending in 2011, Mid Coast Hospital, engaged in an assessment of the health
needs of the mid coast community. This review, called the 2020 Vision, was the most comprehensive
health needs assessment ever performed in our community. All told, over 1,000 community members
attended one of many focus groups to discuss the current and future health needs in our region.
Information from this process was summarized into five major focus areas that became Mid Coast’s
2020 Vision. Finally, clinical, administrative, and population health initiatives were developed and
prioritized into implementation strategies.
The following sets forth the 2020 Vision for Mid Coast and the ongoing transformation necessary to
improve the health of our community:
§ Prevention and Wellness. This involves transforming Mid Coast into an organization that not only
takes care of patients when they become sick but also takes responsibility for the health and
wellbeing of our community.
§ Patient Experience. This involves transforming Mid Coast into an organization that is easy to
navigate and is committed to surpassing expectations in a caring way.
§ Integrated and Accountable Care. This involves transforming Mid Coast into an organization that
uses a team approach to managing the quality and cost of healthcare across all settings, engaging
the patient, employers, and the entire healthcare team in the process.
§ Continuous Improvements to Achieve Superior Outcomes. This involves transforming Mid Coast
into an organization that continuously measures and improves everything we do and engineers
safety, technology, evidence, and reliability into our clinical practices to achieve superior outcomes.
§ Meeting Community Needs. This involves actively engaging with the community to plan for and
meet changing needs, and provides a first place to turn for high-‐quality healthcare, close to home.

Mid Coast’s 2020 Vision is available online at: http://www.midcoasthealth.com/2020-‐vision/
Although not known at the time, Mid Coast’s 2020 Vision process fulfilled the CHNA requirements that
were later articulated in the July 7, 2011 IRS Notice 2011-‐5. This Notice was issued by the IRS to provide
guidance to hospitals in conducting their CHNA. In retrospect, Mid Coast’s process was precisely what
the legislators had in mind as they drafted the CHNA language in the ACA. Because the CHNA
requirements and IRS guidance were issued after the completion of Mid Coast’s 2020 Vision process, the
work was reformatted to better align with the IRS guidance. This FY2011 CHNA is available here.
2 MID COAST HOSPITAL | COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) & IMPLEMENTATION STRATEGIES | FY2014-‐16

Mid Coast Hospital prepared the current, updated CHNA in fiscal year 2014, ending September 30, 2014;
remaining in effect through the end of fiscal year 2016, ending September 30, 2016. Since the last CHNA
was prepared, the State of Maine prepared and disseminated the Maine State Health Assessment,
providing information on the health of Maine people for 167 public health indicators across 22 health
topics. It was from the most recent State Health Assessment, inclusive of Mid Coast Hospital’s primary
service area, that much of the data informing this CHNA were drawn.

Description of the Community Served

Mid Coast Hospital’s primary service area includes the towns of Arrowsic, Bath, Brunswick, Bowdoin,
Bowdoinham, Dresden, Durham, Edgecomb, Freeport, Georgetown, Harpswell, Phippsburg, Richmond,
Topsham, West Bath, Westport, Wiscasset, and Woolwich. The population of Mid Coast’s primary
service area is approximately 87,000, 17% of which are age 65 or older. The primary service area
represents towns where Mid Coast Hospital represents 25% or more of the discharges or Mid Coast’s
discharges are within ten percentage points of the hospital with the greatest share of discharges.

Most of the public health data available in Maine are at the county and public health district levels. Mid
Coast’s service area encompasses all of Sagadahoc County but only a small subset of Cumberland,
Lincoln, and Androscoggin counties. The public health experts at Mid Coast have long recognized this
data deficiency and therefore utilize data from Sagadahoc County as a proxy for its entire service area.i
Data from the Maine CDC for Sagadahoc County show the followingii:
§ Approximately 9% of the population is living at or under 100% of the Federal Poverty Level
§ Approximately 8% of the population does not have health insurance, nearly half of the U.S. rate
§ Approximately 7% of the population is unemployed
§ Approximately 13% of the adult population reports ‘fair or poor’ health
§ Approximately 93% of the population has a ‘usual primary care provider’
§ Approximately 14% of the population has one or more disabilities
§ Approximately 17% of the population has veterans status, 60% more than the national average
§ Approximately 28% of those age 65+ live alone

Methodology

The Maine State Health Assessment (SHA) provides a broad overview of the health of Maine people for
167 public health indicators (data points) across 22 health topics.
The list of 167 indicators was developed with input from the SHA work group as well as subject matter
experts within Maine CDC, utilizing the MAPP Community Health Assessment Processiii. The choices
were based on the best available data, Healthy Maine 2020 objectives; indicators used by other national
and in-‐state health assessments were also considered when choices were made. These indicators are
not inclusive of all public health data, but are intended to provide an overview of public health issues.

Where available and applicable, each indicator was analyzed to provide for:
• Trend data for up to ten years
• Comparison to the US rate or number,
• Data by Maine’s eight geographic public heath districts,
• Data by county,
• Data by gender, and by age,
• Data by race and ethnicity (Hispanic & non-‐Hispanic), and by sexual orientation,
• Data by income and education level
The 2012 SHA includes 22 health status indicators describe many of the issues that affect the health and
wellbeing of people of all ages in Maine. These indicators describe:
• Birth outcomes,
• Causes and rates of death,
• Hospitalizations and emergency room usage,
• Incidence of infectious and chronic diseases,
• Behaviors that affect health, and
• Health care usage and access
The SHA data available in Maine are at the county and public health district levels. As mentioned above,
Mid Coast’s service area encompasses all of Sagadahoc County but only a few towns in Cumberland,
Lincoln, and Androscoggin counties. Mid Coast Hospital therefore utilizes data from Sagadahoc County,
within the Midcoast District Brief as a proxy for its service area.
The local (Mid Coast Hospital service area) analysis of the data presented in the 2012 SHA, and
community health priorities are identified, through a MAPP process facilitated by Access Health. See
Figure 1 below.

Figure 1. Mobilizing for Action through Planning and Partnerships (MAPP) process for Mid Coast
Hospital service area, FY2014
Mid Coast Hospital has had a long and successful collaboration with Access Health, the local Healthy
Maine Partnership (HMP) in the Midcoast region. Access Health is one of 27 local Maine Partnerships,
and one of eight Lead Agencies statewide.iv
Access Health’s mission is to “work with community partners to contribute to the health and wellbeing
of our communities through tobacco prevention & cessation, secondhand smoke reduction, physical
activity & healthy eating promotion, chronic disease management, substance abuse prevention and lead
poisoning prevention.”

In many ways, Access Health, which is governed by an active community advisory board, can be thought
of as an extension of Mid Coast Hospital in carrying out its specific community and public health
initiatives outlined in its mission statement. Every five years, Access Health develops its strategic
priorities based on public health and other data, as well as its ongoing grass roots work in our
community. These strategic priorities are then translated into annual implementation plans, which are
also aligned with the Sagadahoc County Board of Health, as well as the Midcoast District Coordinating
Council. Hence, Mid Coast’s CHNA incorporates the work and priorities of Access Health the local
Sagadahoc County Board of Health, and the Midcoast District Coordinating Council. In addition to the
local county board of health and the District Coordinating Council, Access Health and Mid Coast Hospital
collaborate with many community partners to encourage and support healthy choices, including:
Coordinated School Health Programs of MSAD 75 & RSU 1, Colleges, Faith Community, Fitness Centers,
Healthcare Centers and Hospitals, Libraries, Local Businesses, Non-‐Profit Organizations, Recreation
Departments, Law Enforcement, Schools, and Youth Organizations.

Further, Mid Coast Hospital is an active member of the MaineHealth Community Health Improvement
Council. As a Council member, Mid Coast participates in the MaineHealth Health Index Initiative.v
Priority areas where Mid Coast and other MaineHealth members and partners can substantially improve
population health, are aligned with the issues monitored in the America’s Health Rankings® framework:
• Decrease tobacco use,

• Decrease obesity,
• Increase childhood immunizations,
• Decrease preventable hospitalizations,
• Decrease cancer death rates,
• Decrease cardiovascular death rates, and
• Decrease prescription drug abuse and addiction (added in Maine in 2012)

The data sources used in the above processes included vital records and other public health data from
the Maine CDC, hospital utilization data from the Maine Health Data Organization, population and
demographic data from the Maine State Planning Office, and Strategic and Implementation Plans
provided by Access Health. See Figure 2 below.

Figure 2. Mid Coast Hospital Community Health Needs Assessment Data Sources, FY2014
• MCDC Research and Vital Statistics
• Pregnancy Risk Assessment Monitoring System (PRAMS)
• Maine Integrated Youth Survey
• Behavioral Risk Factor Surveillance System (BRFSS)
• Maine Cancer Registry
• Maine Health Data Organization (MHDO)
• U.S. CDC
• Maine Department of Education

Community Input

As required in Notice 2011-‐5, an individual with expertise in public health participated in the
development of this CHNA. Steve Trockman, MPH is currently the Director of Community Relations and
Outreach at Mid Coast Health Services. In this role Steve leads the organization’s community health
planning and operations. Steve is a graduate of the Rollins School of Public Health at Emory University,
and initially worked as a public health prevention specialist at the U.S. Centers for Disease Control and
Prevention before joining the Maine Center for Disease Control and Prevention. Steve later worked at
Maine Medical Center, leading the region’s public health and health systems emergency preparedness
efforts, including the 2009 H1N1 Influenza Pandemic response.
Maine’s Public Health Districts are coordinated by District Coordinating Councils (DCCs) overseen by the
Maine CDC. DCCs have been charged with monitoring local health status to identify community health
problems. Mid Coast Hospital participates in two District Coordinating Councils (Cumberland and
Midcoast) with a strong leadership role in the Midcoast DCC. Both DCCs have used local SHA results as a
part of a district community health planning process to create District Public Health Improvement plans.

Mid Coast Hospital is also the fiscal agent and lead agency of the local Healthy Maine Partnership (HMP),
Access Health. HMPs are local comprehensive community health coalitions charged with coordinating
local community health needs assessments. In 2012, Access Health adopted a Community Health
Improvement Plan (CHIP) based on the results of a MAPP process -‐ Mobilizing for Action through
Planning and Partnerships. See Figure 3 below. The 2012 CHIP is available online at:
www.accesshealth.org. MAPP is a community-‐driven strategic planning process for improving
community health. This framework helps communities apply strategic thinking to prioritize public health
issues, and to identify resources to address them. This process included representatives from the
following organizations and groups:
• Access Health Advisory Council

• Sagadahoc County Board of Health
• Maine CDC, including district liaisons
• School Health Officials
• Elected officials
• Public Health Experts
• Richmond Area Health Center
• Faith community representatives
• Occupational/Workplace health providers
• Veterans Affairs
• Municipal and County Public Safety
In addition to this 2012 CHIP, every year in September Access Health and Sagadahoc County Board of
Health bring together representatives of these organizations to review population health priorities,
identify resources to improve health behaviors and health outcomes, and report out publicly through a
gap analysis document and implementation strategy document.

Figure 3. Access Health and Sagadahoc County Board of Health Community Health Improvement Plan
(CHIP) model
Community
Local data Input
review
Stakeholder
priorinzanon
Community Health
Improvement Plan

Prioritized Description of the Community Health Needs
The community health needs identified in this assessment are based on the quantitative and qualitative
information collected and tracked in the State Health Assessment and the MaineHealth Health Index
Initiative. With input from the executive committee of the medical staff and the leadership committee
of the employed physician group, Mid Coast’s senior management team held a retreat to prioritize the
identified needs. Strategies were developed to address the priority areas and presented to the Planning
Committee of the Board. Finally, the Board of Directors approved the recommendations of the Planning
Committee at their June 12, 2014 Board meeting. The highest priority needs identified include:
§ Improve access to primary care

§ Reduce the prevalence of childhood obesity
§ Improve the cancer care continuum (prevention, detection, treatment, survivorship)
§ Integrate behavioral health with primary care
§ Improve transitions of care
§ Improve end of life care and coordination
§ Improve parenting support for families during early childhood development
§ Decrease prescription opioid drug abuse and addiction
§ Decrease tobacco use
Table 1 summarizes the Implementation Strategies for the Community Needs Health Assessment. This
information has been reformatted to better align with the IRS guidance.

Table 1. Mid Coast Hospital Community Health Needs Assessment (CHNA) Implementation
Strategies, FY 2014-‐16

Priority Health Anticipated Evaluation Resources &
Needs Strategies Impact Measures Collaboration
Improve Implement extended Increase the number of Change in PCP Mid Coast Medical
Access to hours in the Primary patients, especially patient panels over Group, Oasis Health
Primary Care Care practices. MaineCare, with a PCP time Network (Free
Clinic)

Start construction on Will allow for PCP patient panel
new Primary Care expansion of Primary monitoring Mid Coast Hospital,
practice in Topsham Care Providers Mid Coast Medical
to house new Family Group, Oasis Health
Care Practice (Oct 14) Network (Free
Clinic)

Build new Primary
Care building for Bath Improve access through
Primary Care. capacity expansion, Patient volumes
improved efficiencies
and ease of location
Expand Primary Care Increase the number of

Providers patients receiving
Patient volumes
primary care, especially
family care.
Reduce the Continue to Set the stage for Achievement of Mid Coast Obesity
Prevalence of implement reducing obesity rates Access Health goals Endowment,
Let’s Go! 5-‐2-‐1-‐0 through education of relative to collaborate with
Childhood program throughout
healthy behaviors childhood obesity Access Health,
Obesity region
school systems,

early childhood, and
healthcare
providers
Improve the Maintain Cancer Care Provide more Maintain Maintain CoC
Cancer Care Accreditation comprehensive Cancer Accreditation status meeting
Continuum Care services for requirements
Expand on Outpatient residents of our region
Nutrition Services to Collaborate with

meet the needs of New England Cancer
Cancer Patients Specialists (formerly
Maine Center for
Implement Cancer

Physical Activity Cancer Medicine)
Programs
Integrate Collaborate with Improved Behavioral Clinical outcomes Maine Behavior

Behavioral Maine Behavioral Health Care Health Care
Health Care to Referrals data
Health with
provide Behavioral Improved Access to MCMG-‐Primary
Primary Care services for both the Frequency of visits Care
Health specialists in
patients and providers. data
the Primary Care
setting.
A reduction of no show
rates
Improve Optimize patient Reduce hospital Patient satisfaction MCH

Transitions of centered care readmission rates and readmission
Care transitions across the rates data CHANS
continuum Improve patient and
provider satisfaction SHC
Integrate flow of through improved
clinical information communication and Martin’s Point
between care sites shared clinical
information Maine Health
Develop system wide
standardized patient Improved End of Life Patient and Family
education tools communication Advisory Council

Monitor data related Improved End of Life Transitions of Care
to transitions and planning Cmte (comm-‐wide);
facilitate CHANS Hospice;
Performance Jessica Vickerson,
Improvement. FNP, MSW,
Palliative Care NP

Improved transitions of Transitions of Care
care between sites Cmte (comm-‐wide);
CHANS Hospice;
Jessica Vickerson,
FNP, MSW,
Palliative Care NP
Improve End Collaborate with the Improved End of Life Patient Satisfaction Maine Health and
of Life Care Maine Health End of Communication data MH End of Life
and Life Initiative on the Coordinator Chris
Coordination following topics: Improved End of Life Murray
Planning
Critical Conversation-‐ Jessica Vickerson,
difficult discussions Improved transitions of FNP, MSW-‐ MCH
related to bad care between sites Palliative Care
diagnosis and end of
life CHANS Hospice

POLST training in
Long Term Care CHANS Hospice

Library -‐ death and
Community Advanced dying grant-‐funded
Care Planning research available

ICU/Family meetings

Bereavement

Improve Establish a steering Foster nurturing Program and MCMG and MCH
Parenting committee for the relationships between outcome evaluation
Support for Home Visiting parent and child indicators United Way of Mid
Initiative Coast Maine
Families Improve prenatal care

During Early
Collaborate with Program and Martin’s Point
Childhood Community Protect children from outcome evaluation Health Care
Development Resources to develop preventable indicators
the program, illness and injury State of Maine

specifically the Protect children from Public Health
referral process, violence, Nursing
family assessment, abuse and neglect
home visit, evaluation Maine Families—
and team Increase breastfeeding Sagadahoc and
communications rates Lincoln Counties
(Teen & Young
Implementation of Increase family self-‐ Program and Parent Program)
the Home Visiting sufficiency outcome evaluation
Initiative indicators Maine Families—
Provide educational Cumberland County
resources (The Opportunity

Alliance
Provide referrals to
needed services Early Head Start at
MidCoast Maine
Community Action

Healthy Kids
Decrease Outpatient Primary Achieve 90% utilization Determine rates of MCH Opioid Best
Prescription Care Medical Group for providers utilization through Practices Planning
Opioid Drug providers will quality measures Group, MCMG
participate in the Quality Department
Abuse and
Maine Prescription
Addiction
Monitoring Program

Develop a clinical
Measure # of signed
algorithm for risk Standardization and patient contracts for MCH Opioid Best
stratification and diffusion of best controlled Practices Planning
management of practice. Less medication Group, MCMG
patients for short and prescribing of opioid prescribing Quality Department
long term analgesia medications.

Decrease Collaborate and Reduction in the State CDC Community Health
Tobacco Use continue to support number of teens and Assessment Data and Wellness
Access Health in adults in community Department at Mid
accomplishing their who smoke Coast Hospital
strategic priorities
Access Health
Support the role of
the hospital
Pulmonary Educator
in order to expand
smoking cessation
support to MCH staff,
patients and
community members.
Integrate smoking
cessation programs
into the Primary Care
Offices
Maintain Tobacco
Free environment
throughout MCHS
campuses
Existing Healthcare Facilities and Other Resources Available to Meet Community Needs
• Mid Coast Health Services

o Mid Coast Hospital (and all employed physicians)
§ Mid Coast Medical Group
§ Access Health, a Healthy Maine Partnership
§ Addiction Resource Center
o Community Health and Nursing Services (CHANS Home Health Care and Hospice)
o Mid Coast Senior Health Center
• Other Hospitals
o Maine Medical Center
o LincolnHealth – Miles Campus
o Mercy Hospital
o Parkview Adventist Medical Center
o St. Mary’s Health System
o Central Maine Medical Center
• Other Healthcare Providers
o Martin’s Point Health Care

o Richmond Area Health Center
o Numerous Private Primary Care and Specialty Provider Practices
o OASIS Health Network – Free Clinic
o Maine Mental Health Partners – Community Counseling Center
o Family Planning of Maine
o Jessie Albert Dental Center
• Charitable and Social Service Resources
o United Way of Mid Coast Maine
§ Success By 6: Early Childhood
• Bath Area Family YMCA
• Coastal Trans, Inc.
• Family Focus
• Healthy Kids! A Family Resource Network
• Midcoast Maine Community Action
• Teen and young Parent Program
• Tri County Literacy
§ Youth & Lifelong Learning
• Bathy Area Family YMCA
• Big Brothers Big Sisters of Bath/Brunswick
• People Plus Center and People Plus Teen Center
• Tri County Literacy
§ Basic Needs/Safety Net
• Coastal Trans, Inc.
• Good Shepard Food Bank
• Mid Coast Hunger Prevention Program
• Midcoast Maine Community Action
• Spectrum Generations
• Tedford Housing
§ A Safe & Healthy Community
• All About Prevention
• Catholic Charities of Maine
• Family Crisis Services
• Mid Coast Chapter American Red Cross
• MSAD 75 School Based Health Center
• Oasis Health Network
• Pine Tree Legal Assistance
• Planned Parenthood of Northern New England
• Respite Care

• Sexual Assault Support Services of Midcoast Maine (SASSM)
• Sweetser
o American Red Cross, Mid-‐Coast Maine Chapter
o American Cancer Society
o American Heart Association
• Other Resources
o Bath Area Family YMCA
o Casco Bay YMCA
o Elmhurst, Inc.
o Woodfords Family Services
o Habitat for Humanity/7 Rivers
o Head Start

NOTES

i
The 2013 population estimate for Sagadahoc County, Maine is 35,013. Source: Sagadahoc County QuickFacts from
the US Census Bureau. Retrieved from: http://quickfacts.census.gov/qfd/states/23/23023.html
ii
Maine Center for Disease Control and Prevention. (2013, May 20). Maine State Health Assessment – Midcoast
District Brief. Retrieved from http://www.maine.gov/tools/whatsnew/attach.php?id=478443&an=2
iii
Mobilizing for Action through Planning and Partnerships (MAPP) is a community-‐driven strategic planning
process for improving community health. Facilitated by public health leaders, this framework helps communities
apply strategic thinking to prioritize public health issues and identify resources to address them. MAPP is not an
agency-‐focused assessment process; rather, it is an interactive process that can improve the efficiency,
effectiveness, and ultimately the performance of local public health systems. (2014, June 24). Mobilizing for Action
through Planning and Partnerships (MAPP). Retrieved from: http://www.naccho.org/topics/infrastructure/mapp/
iv
The Healthy Maine Partnership project is a collaborative effort among 26-‐28 local coalitions, the Maine
Department of Health and Human Services (Maine CDC and Office of Substance Abuse) and Department of
Education, supported primarily by the Fund for a Healthy Maine with federal grants from U.S. CDC, Substance
Abuse and Mental Health Services Administration (SAMHSA), and U.S. Department of Education. Mid Coast
Hospital is the fiscal agent and lead agency for Access Health.
v
The MaineHealth Health Index Initiative was launched in 2009-‐10 with the two-‐fold aim of:
• Engaging MaineHealth, Maine’s largest integrated health system, and its partners to use health data to
inform needs and opportunities to improve the health of the nearly 1.0 million people in the 11 counties
served by the MaineHealth system
• Monitor improvements made in health status over time
The Health Index Initiative focuses on seven priority areas where MaineHealth and its partners can substantially
improve population health. The initial six priorities, selected in 2009, were drawn from issues monitored in the
America’s Health Rankings® framework: Decrease tobacco use, Decrease obesity, Increase childhood
immunizations, Decrease preventable hospitalizations, Decrease cancer death rates, and Decrease cardiovascular
death rates. "Decrease Prescription Drug Abuse and Addiction" was added as a seventh priority in 2012. (2014,
June 24). MaineHealth Health Index Initiative Reports. Retrieved from: http://www.mainehealth.org/healthindex

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Mid Coast Hospital | Community Health

• Trend data for up to ten years

• Comparison to the US rate or number,

• Data by Maine’s eight geographic public heath districts,

• Data by county,

• Data by gender, and by age,

• Data by income and education level

• Causes and rates of death,

• Hospitalizations and emergency room usage,

• Incidence of infectious and chronic diseases,

• Behaviors that affect health, and

• Health care usage and access

• Decrease tobacco use,

• Access Health Advisory Council

§ Improve access to primary care

Expand Primary Care Increase the number of

Integrate Collaborate with Improved Behavioral Clinical outcomes Maine Behavior

Improve Optimize patient Reduce hospital Patient satisfaction MCH

• Mid Coast Health Services

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